180567 12/16/2009 CITY OF CARMEL, INDIANA VENDOR: 355549 Page 1 of 1
j. ONE CIVIC SQUARE Y M C A
i
CARMEL, INDIANA 46032 615 N ALABAMA ST SUITE 200 CHECK AMOUNT: $211.80
INDIANAPOLIS IN 46204 -1359 CHECK NUMBER: 180567
CHECK DATE: 12/16/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4341980 1197499 211.80 WELLNESS PROGRAM
YMCA of Greater Indianapolis 1212!2009
615 N Alabama St Suite 200
Indianapolis IN 46204 -1359 Invoice No. 1197499
(317) 266 -9622 fax. (317) 266 -2845
G
INVOICE
Bill to: City of Carmel 317 571 -5850
Attn: Michele Whittington D
Human Resources, 1 Civic Square
Carmel, IN 46032 DEC 1 4 2f�g
By
YMCA membership fees for the month of
December 2009
Name YMCA Employee Employer Type Date of Birth Remarks
Allen, Brad 07- 167698 0400 10.95 Adult HH 2
Subtotals 0.00 211.80
20 employees Total Due $211.80
Please remit to:
YMCA of Greater Indianapolis Terms: Net 30 days
615 N: Alabama Street
Indianapolis, IN 46204
Page 1
YMCA membership fees for the month of
December 2009
Name YMCA Employee Emplover Type Date of Birth Remarks
Additions this period:
None
Cancellations this period:
None
i
Page 2
?rescri�ed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
YMCA Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/02/09 1197499 Gym Membership 211.80
Total $211.80
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
2Q
Clerk- Treasurer
VOUCHER NO 2 14 09 WARRANT NO.
ALLOWED 20
YMCA
IN SUM OF
615 N Alabama St., Suite 200
Indianapolis, IN 46204
$211.80
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human R esources
Board Members
DEPT or INVOICE NO. ACCT# /TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1197499 419 -80 1211.80 materials or services itemized thereon for
which charge is made were ordered and
received except
20
SGgnat
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund